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Magazine Blasts Teleradiology ‘Hidden Dangers’

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Self magazine slams teleradiology in an article posted on the magazine’s Web site and the MSNBC site.

The magazine headline reads “The Hidden Dangers of Outsourcing Radiology.” The subhead elaborates: “That scan of your brain, bones or breasts you got last Tuesday? It might have been read by someone who isn’t a doctor and lives 12 time zones away. If, that is, anyone has bothered to read it at all.”

The MSNBC site headlines the same article: “Is a doctor reading your X-rays? Maybe not.”

Writer Katherine Eban, an investigative reporter who writes frequently about health issues, notes the benefits of teleradiology, but adds:

Although teleradiology can improve care by allowing access to specialists, a Self investigation found that it also opens the door to confusion, errors and outright fraud. In the shuffle of reporting between remote strangers, crucial information can get lost, with reports never relayed, winding up in the wrong file or arriving after a patient has been discharged. Radiologists may also lack the context necessary to understand what they are seeing.

The article tells stories of teleradiology gone horribly wrong, beginning with the case of a woman who showed up at a rural Pennsylvania hospital with a horrific headache. A teleradiologist read a CT scan and found a possible tumor. The hospital made a follow-up appointment and discharged the woman.

She returned hours later in agonizing pain. A second CT scan with contrast dye went to a subcontracting teleradiologist. He noted in his report a ring around the possible tumor but didn’t explain the significance. The emergency doctor who read the report didn’t know the significance and didn’t ask. Another teleradiologist who reread the scan a few hours later also noticed the ring but didn’t contact the hospital because he knew the information had been passed along.

The woman was discharged again. Two days later, the abscess in her brain—the ring—ruptured. She survived 11 weeks in a coma but has permanent brain damage.

Other cases that will be familiar to readers of this blog involve the 1,289 mammography scans at Perry (Georgia) Hospital that were never read, though the patients got “all clear” letters, and the Atlanta teleradiologist who signed and submitted reports on more than 70,000 images but actually looked at fewer than 5,900.

Self reveals that though the accused Perry Hospital radiology technician worked for the hospital, the doctors whose forged electronic signatures were attached to the scans did not. They worked for Universal Radiology Consultants, a teleradiology company in nearby Warner Robins, Georgia.

The article acknowledges, “Teleradiology is here to stay: Hospitals are not going to trade cutting-edge digital equipment for old-school films, nor will cash-strapped facilities hire round-the-clock radiologists.”

If the teleradiology problem is not going away, then what is the solution? Teamwork, the article says:

Superior teleradiology companies offer video conferencing between radiologists and clinicians, sometimes patching in the patient.

The article is tough stuff. Expect questions from patients who have read it.

Related seminar: Neuroradiology Review

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One Response to “Magazine Blasts Teleradiology ‘Hidden Dangers’”

  1. Steven on November 1st, 2011 at 4:11 pm

    Katherine Eban’s story in the Self Magazine October issue “The stranger reading your X-ray may be 8000 miles away”, reports on several unfortunate incidents where patient care suffered. The fraud convictions speak for themselves, and are universally condemned by the radiology profession. The lack of teamwork and communications within the care delivery teams cited in the other cases is, perhaps ironically, something that teleradiology technology actually improves.

    Teleradiology became common in the last 10-15 years as images became digital, and the internet enabled their rapid transmission from the hospital to the radiologist. It is now possible for a subspecialty trained radiologist to view the scan, whether onsite or not. The centralized Virtual Radiologic (vRad), operations center can access the patient need with an appropriate subspecialist 24/7/365. All our physicians have medical licenses issued by the states in which the patients are imaged and individually credentialed by the hospitals they serve. Importantly more than 75% are subspecialty trained. The result is an expert diagnosis within minutes.

    The benefit doesn’t end with prompt access to subspecialists. Communications between the radiologist and the patient’s physician is critical to patient care. Virtual Radiologic’s technology, used by both local radiology practices and vRad physicians, connects the radiologist with the patient’s physician with “one touch” phone connection for critical cases such as those described in the article.

    Virtual Radiologic radiologists read more than seven million studies per year, with industry leading accuracy. More than 30,000 of those reports include critical findings with a telephone connection to the patient’s physician occurring on average within seven minutes. vRad’s technology can connect the patient’s physician and radiologist more quickly than the former “walk down the hall”.

    In addition to providing greater access to subspecialty trained radiologists and facilitating effective communications, teleradiology also enables better collaboration between radiologists. Rapid transmission of a complex study to a second physician can provide confirmation of a difficult diagnosis. What’s more, the results can even be delivered to the patient’s physician’s iPad or iPhone, bringing the interpretation directly to the point of care within minutes of the scan.

    The examples cited in the article are indeed unfortunate. However, the technology associated with teleradiology, and the extended network of radiologists it accesses, should be credited with enhancing patient care, not degrading it.

    Sincerely,

    Steven H. Brick, M.D. | Medical Director | vRad